通痹汤加减联合艾灸治疗类风湿性关节炎临床疗效及对血清炎性因子的影响

Tongbi Decoction Combined with Moxibustion in the Treatment of Rheumatoid Arthritis(Cold Bi)and Its Effect on Serum Inflammatory Factors

目的观察通痹汤加减联合艾灸治疗类风湿性关节炎(寒痹)的临床疗效及对血清炎性因子的影响,以期为临床治疗类风湿关节炎提供思路。方法纳入2016年2月—2019年2月惠州市第六人民医院就诊类风湿性关节炎(寒痹)患者90例,采用随机数字表法分为治疗组和对照组,每组45例。两组均给予常规药物治疗(甲氨蝶呤+塞来昔布胶囊),治疗组在此基础上给予通痹汤加减联合艾灸治疗,连续治疗90 d,观察治疗前后两组有效率、中医证候量表评分(晨僵、压痛关节数、肿胀关节数、疼痛评分、关节肿胀)、血清基质金属蛋白酶-3、9(MMP-3、MMP-9)、肿瘤坏死因子-α(TNF-α)、血清类风湿因子(RF)、C反应蛋白(CRP)、血沉(ESR)及不良反应发生情况。结果治疗组治疗后痊愈率、有效率、总有效率优于对照组(P<0.05);两组治疗后临床症状指标(关节肿胀度、压痛程度、关节疼痛数目、晨僵持续时间)及中医证候量表评分与本治疗前比较均明显改善(P<0.01),且治疗组均优于对照组(P<0.05),差异具有统计学意义;治疗90 d后,两组血清炎性因子(MMP-3、MMP-9、TNF-α)与类风湿因子(RF)、C反应蛋白(CRP)、血沉(ESR)水平与治疗前比较明显改善(P<0.01),且治疗组改善更明显。结论通痹汤加减联合艾灸治疗类风湿性关节炎(寒痹)确有良好的效果,值得临床推广应用。

Objective To observe the effect of Tongbi Decoction combined with Moxibustion on rheumatoid arthritis(RA)and serum inflammatory factors in order to provide effective treatment for clinical treatment of RA.Methods Ninety patients with rheumatoid arthritis(cold arthritis)from February 2016 to February 2019 were randomly divided into treatment group and control group.45 cases in each group.Both groups were given conventional medication(methotrexate 4.5 mg/week+celecoxib capsule 0.2 g twice a day).On this basis,the control group was given Tongbi Decoction plus or minus combined moxibustion treatment for 90 days.The effective rate,TCM Syndrome Scale score(morning stiffness,tenderness joint number,swelling joint number,pain score,joint swelling),serum matrix metalloproteinase metalloproteinase-3,9(MMP-3,MMP-9),serum inflammatory factors,tumor necrosis factor-α(TNF-α),serum rheumatoid factor(RF),C-reactive protein(CRP)were observed before and after treatment.Erythrocyte sedimentation rate(ESR)and adverse reactions.Results The cure rate was 53.3%,the effective rate was 35.6%,and the total effective rate was 88.9%.The complete cure rate was 31.1%,the effective rate was 44.4%and the total effective rate was 75.5%in the control group.There was significant difference between the two groups(P<0.05).The clinical symptoms of the two groups before and after treatment(joint swelling degree,tenderness course)were significantly different(P<0.05).The scores of degree,number of joint pain and duration of morning stiffness in the treatment group were better than those in the control group(P<0.05).3.There were significant differences in the levels of MMP-3,MMP-9 and RF,C-reactive protein(CRP),erythrocyte sedimentation rate(ESR)between the two groups before and after treatment.The treatment group was better than the control group(P<0.05).Conclusions Tongbi Decoction combined with moxibustion has a good effect on rheumatoid arthritis(cold arthritis),which is worthy of clinical application and promotion.